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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
410508766
Report Date:
12/21/2022
Date Signed:
12/21/2022 04:22:09 PM
Document Has Been Signed on
12/21/2022 04:22 PM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC
,
851 TRAEGER AVE., SUITE 360
SAN BRUNO
,
CA
94066
FACILITY NAME:
RICE RESIDENTIAL CARE FACILITY
FACILITY NUMBER:
410508766
ADMINISTRATOR:
PALATTAO, RUBY M.
FACILITY TYPE:
735
ADDRESS:
45 RICE STREET
TELEPHONE:
(650) 992-8076
CITY:
DALY CITY
STATE:
CA
ZIP CODE:
94014
CAPACITY:
5
CENSUS:
0
DATE:
12/21/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
02:30 PM
MET WITH:
Ruby Palattao
TIME COMPLETED:
04:30 PM
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On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management inspection visit. The purpose of today's visit is to inspect the facility's physical plant to ensure that the renovations that took place are complete so that residents can move back into the facility. LPA met with the licensee and explained the purpose of today's visit.
During today's visit LPA made observations through out the facility. There are no residents present during this inspection. This is a two story facility. Resident reside on the upper floor of the facility where the main entrance leads to. Living room is inspected as having the required furniture. Kitchen cabinets and appliances are in place and functioning including a lock closet for medication storage and knife storage. Food supplies are present. Three resident bedrooms are observed. Female bedroom is not shared. Two male bedrooms are observed as shared. All three rooms have required furniture in place including beds and bedding. Bathroom in common hallway is observed as functioning and in place. Flooring through out the upper floor is in place. Walls in the kitchen need to be painted but there are no holes or loose building materials present on the upper floor. Facility ambient temperature is comfortable. All lighting is available through out the facility. There have been no changes to the physical plant on both the ground floor and upper floor.
Facility is observed as able to house residents as of today.
Report is reviewed with licensee Ruby Palattao.
SUPERVISORS NAME
:
Cara Smith
LICENSING EVALUATOR NAME
:
Jaime Vado
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/21/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
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